Hysterectomy for Endometrial Cancer

Surgery Overview

A hysterectomy is the surgical removal of a
woman's uterus. A hysterectomy to remove
endometrial cancer usually includes the removal of the
ovaries and
fallopian tubes (bilateral salpingo-oophorectomy).
Your doctor may also do a pelvic and para-aortic lymph node biopsy to find out
the stage and grade of the cancer. Most cases of
endometrial cancer are diagnosed during the earliest stage, while cancer is
still contained in the uterus and can be cured.

Your surgery will
depend on how much of your reproductive system may be affected by endometrial
cancer.

A total hysterectomy with
bilateral salpingo-oophorectomy is the removal of the uterus, cervix, fallopian
tubes, and ovaries. This is the most common surgery done for endometrial
cancer.

A radical hysterectomy is the removal of the uterus,
cervix, surrounding tissue, upper vagina, and usually the
pelvic lymph nodes. The number of lymph nodes removed depends on how far the
cancer has spread.

A hysterectomy for endometrial cancer may be done with an incision (cut) in the abdomen. Sometimes a laparoscopic hysterectomy is possible. In both procedures,
general anesthesia usually is used. The type of
hysterectomy you have depends on your medical history and general state of
health and on the extent of the cancer growth. Medical centers and surgeons may
prefer to do the type of surgery that they have more experience with. Pelvic
and para-aortic lymph nodes will be biopsied during surgery to help find out the
stage of cancer.

Abdominal hysterectomy:
The uterus, ovaries, and fallopian tubes are removed through an incision (laparotomy) in the lower abdomen.

An abdominal incision provides a large
opening into the abdomen for the surgeon to easily see the organs and to
find out the extent of the cancer.

An abdominal hysterectomy will
leave a scar (usually 5 inches) on the abdomen.

The usual stay in
the hospital after an abdominal hysterectomy is 3 days.

Laparoscopic hysterectomy: Laparoscopic surgery is done with a tiny camera and special instruments. The surgeon puts these tools through several small incisions (cuts) in the belly.

In a laparoscopic hysterectomy, the surgeon usually is able to see the organs well enough to find out the extent of the cancer.

A laparoscopic hysterectomy leaves several very small scars on
the abdomen.

You may stay in the hospital for 1 or 2 days after
a laparoscopic hysterectomy. Or you may be able to go home the same day.

When done by an experienced surgeon, laparoscopic hysterectomy
may have a quicker recovery and fewer complications than abdominal
hysterectomy.

Some surgeons do this surgery by guiding robotic arms that hold the surgery tools. This is called robot-assisted laparoscopy.

What To Expect After Surgery

Right after surgery, you will be taken
to a recovery area where nurses will care for and observe you. Usually the stay
in the recovery area is for 1 to 4 hours. You will then be moved to a hospital
room. In addition to any special instructions from your doctor, your nurse will
explain information to help you during your recovery.

You will
likely stay in the hospital 1 to 4 days after a hysterectomy. About 4 to 6
weeks after the hysterectomy, your doctor will examine you in his or her
office. You should be able to return to all of your normal activities,
including having sexual intercourse, in about 6 to 8 weeks. Some light bleeding
or spotting is expected for up to 6 weeks following a hysterectomy. If your
vaginal bleeding is heavier or different from what you were told to expect,
call your doctor.

After you have a hysterectomy, you will not be
able to become pregnant.

After a hysterectomy, call your doctor
if you have:

Chest pain, a cough, or trouble
breathing.

Bright red vaginal bleeding that soaks two or more pads
in an hour or forms large or painful clots.

Pain or tenderness,
swelling, or redness in your legs.

A fever of
100.4°F (38°C) or
higher.

Pain that is not relieved by your pain medicine or pain
that is getting worse.

Pus coming from your incision.

Trouble passing a stool, especially if you have not had a
normal bowel movement for 3 to 5 days or if you have mild pain or swelling in
your lower abdomen.

Trouble passing urine, pain or burning when
you urinate, blood in your urine, or cloudy urine.

Pain,
discomfort, or bleeding during intercourse.

Hot flashes, sweating,
flushing, or a fast or pounding heartbeat.

Why It Is Done

Endometrial cancer most often occurs
in the inner lining of the uterus and is contained within the uterus in the
earlier stages. Removal of the uterus reduces the risk of cancer recurring or
spreading. The ovaries are a common site for spread (metastasis) of endometrial
cancer cells and so are almost always removed at the same time.

How Well It Works

Removal of the uterus, fallopian
tubes, and ovaries reduces the risk of spread or recurrence of endometrial
cancer.

Risks

Most women do not have complications after a
hysterectomy. But complications that may occur include:

You may have other physical problems after a
hysterectomy. In some women, the pelvic muscles and ligaments that support the
vagina, bladder, and rectum may become weak. The weakness may cause bladder or
bowel problems, such as
cystocele, urinary incontinence, or
rectocele.
Kegel exercises may help strengthen the pelvic muscles
and ligaments. But some women need other treatments, including additional
surgery.

Vaginal dryness may develop if your ovaries were removed
during your hysterectomy. If sexual intercourse is painful because of vaginal
dryness, use a vaginal lubricant, such as K-Y Jelly or Astroglide, or a
polyunsaturated vegetable oil that does not contain preservatives. Do not use
petroleum jelly (for example, Vaseline) as a lubricant, because it increases
the risk of vaginal irritation and infection.

Your doctor will
tell you how long you should wait after surgery before engaging in sexual
intercourse. Pain during intercourse (dyspareunia) may occur if your vagina was
shortened during your hysterectomy. Changing positions may help make
intercourse less painful. If you continue to have difficulty with intercourse
after a hysterectomy, talk with your doctor.

What To Think About

It is normal to feel a variety of
emotions about having a hysterectomy. These are often based on beliefs about
the importance of your uterus, fears about your health or your personal
relationships, and
concerns about your enjoyment of sexual activities
after surgery. If you do have sexual problems after your surgery, talk with your doctor. He or she will be able to help you or direct you to a specialist who can help. To learn more, see the topic Sexual Problems in Women.

The hospital or surgery center may send you
instructions on how to get ready for your surgery or a nurse may call you with
instructions before your surgery.

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